Merit Corporation Pre-Employment Questionnaire

Merit Corporation Pre-Employment Questionnaire

Application for Employment Equal Opportunity Employer

Name (Last Name First)
Morgan Cummings / Social Security No.
xxx-xx-xxx

Present Address

404 East 24 & 40 Hwy /

City

Tonganoxie /

State

KS /

Zip

66086

Permanent Address

25480 187th street /

City

Leavenworth / State
KS / Zip
66048
Phone No.
913- 845-2654 /

Fax

913-845-3778 /

E-Mail

Employment Desired

Position

Bank Teller /

Date You Can Start

immediately /

Salary Desired

Negotiable/minimum wage

Are You Employed? Yes No / May We Contact Your Present Employer? Yes No
Please contact previous employer
Education
Name & Location of School / Years
Attended / Date of Graduation / Major

High School

Leavenworth HS / Leavenworth, KS / 1974-1977 / May 1977 / NA
Postsecondary School
Kansas State University / Manhattan, KS / 1977 - 1981 / May 1981 / Spanish Education, BA
Trade, Technical School
Other
Kansas State University / Manhattan, KS / 1996 - 1998 / May 1998 / Secondary Education, MS
Employment (list most current first)
Date
Month and Year / Name and Address / Salary / Position / Reason for Leaving
From
August 1989 / Tonganoxie High School USD 464
404 east 24 & 40 Hwy / $Xx,xxx.xx / Teacher / Still employed
To
Present / Tonganoxie, KS 66086
From
August 1984 / Osage City High School / $xx,xxx.xx / Teacher / Moved closer to family
To
May 1989 / Osage City, KS 66054
From
August 1981 / Wray High School / $xx,xxx.xx / Teacher / Returned to KS
To
May 1984 / Wray, CO 66076
From
To
List Your Computer and Related Skills
I am proficient in word, excel and have training in animation technology.
References: List below at least two referencesListGi
Name / Address / Phone number
Jamie Carlisle / 404 E. 24 & 40 Hwy Tong. KS / 913-845-2654
Jennifer Smith / 26783 182nd street Leav. KS / 913-682-8741

Writing Sample

What do you feel you can bring to this company?

I feel that I am a hardworking individual with a solid work ethic. I am excited to gain experience in this field as I hope to earn …….and become employed in this industry upon completion of my training/graduation.
I enjoy working with people and feel that I will be a positive representative of this company.
I have previous training in this field and feel that I can make a significant contribution to your company.
I have always enjoyed working with my hands and I have gained a great deal of training in my high school building trades class. I am looking forward to working with this company.

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

Date Signature